1 RIte Care’s Culture of Continuous Improvement Based on Research & Data Analysis Presentation to Academy Health- State Health Research and Policy Interest.

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Presentation on theme: "1 RIte Care’s Culture of Continuous Improvement Based on Research & Data Analysis Presentation to Academy Health- State Health Research and Policy Interest."— Presentation transcript:

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5 Culture of Continuous Improvement Environment –Insist on data driven policymaking and program design –Focus on data-based decision making prevents decision making based on anecdotes and bias, which can be divisive and result in bad programs –Openness to participation in data analysis and discussion at all levels. “If you’re interested, you’re welcome” –Encouragement & support of any effort made to apply data analysis & research to program development –Openness to critique– “seen as an opportunity for improvement” –Respect for different standards and motivations of policy & program staff and academic researchers

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8 RIte Care Created in 1994 under Medicaid R&D waiver with the following goals: 1.Reduce uninsurance for low-income children and families 2.Improve access, service quality and health status for the covered population 3.Control the rate of growth in Medicaid expenditures for the eligible population

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12 Percent Uninsured Rhode Island Children < 18 Years Old Data Source: Medicaid Research and Evaluation Project, RI Access Project US Bureau of the Census, Current Population Surveys (September estimates) 2nd1st2nd3rd1st3rd National Ranking 8th25th2nd

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13 RI saw a Decrease in Employer Sponsored Coverage Erosion in employer-based coverage has resulted in an increase in the state's uninsurance rate. In 2000, 77.7% of the population was covered by employer-based insurance and that percentage decreased to 68.4% in 2003.

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18 Performance Incentive Program Three types of performance goals: –Access –Clinical –Administrative Performance goals were selected to represent: –key areas of Health Plan performance - age and gender of the RIte Care population Use of HEDIS measures plus other measures specific to the population, such as lead screening

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31 Goal 3: Control the rate of growth in Medicaid expenditures for the eligible population

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32 RIte Care: Cost-Efficient RIte Care: Cost-Efficient “ A few states have revamped their organizational and management systems to ensure better access to medical care while keeping costs under control. Rhode Island stands out in this respect.” Governing Magazine, Feb 2004

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33 Lessons Learned

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34 “Lessons for other States” Building Quality into RIte Care: How RIte Care is Improving Health Care for Its Low-Income Populations by Sharon Silow-Carroll* Start Early to Establish a Baseline Use the Data in a Variety of Ways Integrate Research into the Medicaid Program Use Interdisciplinary Team Ensure Access to Data Acknowledge Trade-offs in Subsidizing Private Health Coverage Supplement Research and Evaluation with Outside Funding Monitor Long Term Goals *Field Report, The Commonwealth Fund, January 2003